1. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENTFPS PUBLIC HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Medical Imaging Federal initiative Dr Aldo Perissino (internal medicine and public health)

2. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Organisers  Federal Public Health Service  National Insurance Institute  Federal Agency Nuclear Control

3. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Imaging techniques Radiology Conventional radiology CT scan Interventional radiology Nuclear medicine Mixed Modality (CT + PET,…)

4. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Position of the problem  Widespread access  Appropriateness of chosen examinations The exposure to ionising radiations grew drastically these last years.  Belgium is among the greatest “irradiating countries”  1 person in 5 has a CT each year  Every person in Belgium has one X-ray examination each year (2008)

5. Positioning the problem Mean exposure to medical irradiation in various countries Source: UNSCEAR rapport 2008 X 1,5 X 4

6. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Target Framework: a set of initiatives aiming at the optimisation of the use of medical imaging Workgroups:  Accreditation and optimisation  Guidelines  Awareness campaign  Inform  Raise awareness

7. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Campaign: target groups The population Indirect impact on prescribers and professionals The prescribers The performers

8. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Target group: Population and patients  Inform on the opportunity of medical imaging  Call upon awareness and stimulate it:  An examination must have an indication  When indicated, an examination has to be performed

9. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Target group: Prescribers  Family practitioners and specialists  Better choice of examinations:  guidelines and “folia”  Improve communication with patients:  indirect effect of the campaign

10. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Target group: Performers  Radiologists, Technicians, Nurses:  accreditation and optimisation  directives  Performers = gatekeeper  Better communication between performers and prescribers:  Indirect effect of the campaign and the spreading of information

11. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Target group: Performers Interventional procedures: awareness of impact and doses delivered Dosimetry

12. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Key points  Justification: every procedure must be indicated Provided that the indication is correct, irradiation is a secondary matter, on behalf of what follows:  Optimisation: limit irradiation strictly to the need (ALARA) If a non-irradiating technique of equal value is available, it should be preferred

13. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Key points  Protect frail groups:  pregnancy  children

14. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Campaign themes  Quality !  Awareness  Reduction of unnecessary exposure  No compulsion

15. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Radiation protection of staff in fluoroscopy Radiation protection of staff in fluoroscopy Radiation protection of patient in fluoroscopy http://rpop.iaea.org

16. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Radiation protection of patient in fluoroscopy 1. Maximise distance between patient and tube to the extent possible 2. Minimise distance between patient and image receptor 3. Minimise fluoroscopy time 4. Use pulsed fluoroscopy with the lowest frame rate possible to obtain images of acceptable quality 5. Avoid exposing the same area of the skin in different projections 6. Larger patients or thicker body parts trigger an increase in entrance surface dose (ESD) 7. Oblique projections also increase ESD 8. Avoid the use of magnification 9. Minimize number of frames and cine runs to clinically acceptable level 10. Use collimation

17. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Radiation protection of staff in fluoroscopy http://www-ns.iaea.org/tech-areas/communication-networks/norp/isemir-web.htm

18. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Radiation protection of staff in fluoroscopy 1.Use protective devices 2.Make good use of time-distance-shielding (TDS) principle 3.Use ceiling suspended screens, lateral shields and table curtains 4.Keep hands outside the primary beam unless totally unavoidable 5.Only 1% - 5% of radiation falling on the patient’s body exits the other side 6.Keep X ray tube under the patient table and not over it 7.Use personal dosimetry - Use at least two dosimeters 8.Update your knowledge about radiation protection 9.Address your concerns about radiation protection to radiation protection specialists 10.REMEMBER! Quality – Equipment - Injectors

19. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Conclusion  Reduce (suppress?) useless examinations  Part of a broader action plan  Awareness  Communication  Patient empowerment

20. FPS HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT Thanks for listening !